Director, Pharmacy Revenue Integrity

Job Description

General Summary :

Under the general supervision of the Vice President for Pharmacy services, is responsible for, but not limited to, all pharmacy cost and revenue related activities such as report preparation, department audits, reconciliation procedures, QA monitoring, denials management, revenue-based statistics, CDM (Charge Description Master) maintenance, training clinical staff on charge-capture processes and subsequent charge review post procedure.

Duties and Responsibilities :

The following are essential job accountabilities :

• Supports cost and revenue impact decision making related to new drug / biosimilar product addition and removal from formulary.
• Provides assistance to all pharmacy revenue generating departments to ensure uniform application of the Charge Master in all areas, regulatory agency compliance and compliance with System policies and procedures.
• Coordinates departmental Charge Master reviews and recommends price increase changes as needed.  Provides education and assistance to the pharmacy director and managers regarding function of the Charge Master.
• Ensures appropriate compliance with Charge Master and revenue capture processes for new pharmacy services being considered by the facility.
• Performs department charge process and charge reconciliation audits to ensure compliance with hospital and department policy and procedures; creates and modifies policies and procedures relating to gross revenue and reconciliation processes.
• Oversees all patient charge audits.
• Monitors departmental usage of reports to ensure issues are being identified and addressed with continuous quality improvements in addition to providing education to departments on improving pharmacy revenue accuracy.
• Builds collaborative relationships with internal and external stakeholders to execute revenue cycle management goals and objectives.
• Coordinates charge capture audits with the appropriate teams to identify charge capture loss, identifies the gaps and process improvement opportunities, identifies and implements best practice resolutions, communicates changes, metrics and ongoing improvement initiatives.
• Works with all personnel involved in the pharmacy revenue cycle to optimize technology in the charge capture process.
• Supports timely resolution of issues, provides incident management and problem resolution.
• Assists external departments in denial management.
• Work with strategic sourcing and GPO for contract performance and financial impacts
• Create P&L for all medications and advises P&T on inpatient and outpatient formulary

The following are common expectations :

Education / Experience :

Skills / Qualifications :

About US

At Atlantic Health System, our promise to our communities is; Anyone who enters one of our facilities, will receive the highest quality care delivered at the right time, at the right place, and at the right cost. This commitment is also echoed in the respect, development and opportunities we give to our more than 20,000 team members. Headquartered in Morristown, New Jersey, we are one of the leading non-profit health care systems in the nation. Our facilities and sites of care include :

We also have more than 900 community-based healthcare providers affiliated through Atlantic Medical Group. Atlantic Accountable Care Organization is one of the largest ACOs in the nation, and we are a member of AllSpire Health Partners.

We have received awards and recognition for  the services we have provided to our patients, team members and communities. Below are just a few of our accolades :

Atlantic Health System offers a competitive and comprehensive Total Rewards package that supports the health, financial security, and well-being of all team members. Offerings vary based on role level (Team Member, Director, Executive). Below is a general summary, with role-specific enhancements highlighted :

Team Member Benefits

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Note : In Compliance with the NJ Pay Transparency Act (effective Sunday, June 1, 2025), all job postings will include the hourly wage or salary (or a range), as well as this summary of benefits. Final compensation and benefit eligibility may vary by role and employment status and will be confirmed at the time of offer.

EEO STATEMENT

Atlantic Health System, Inc. is an equal employment opportunity employer and federal contractor or subcontractor and therefore abides by applicable laws to protect applicants and employees from discrimination in hiring, promotion, discharge, pay, fringe benefits, job training, classification, referral, and other aspects of employment, on the basis of race, color, religion, sex (including pregnancy, gender identity and sexual orientation), national origin, citizenship status, disability, age, genetics, or veteran status.